Rationale and Feasibility of Transcatheter Pulmonary Valve Implantation in Small Conduits with the Edwards Sapien Valves

Objectives: Some guidelines do not recommend conduit dilatation above 110% and TPVI in conduits <16 mm. However, if we want to reach normal values for RVOT diameters and diminish reintervention rates, pushing these boundaries is essential.

Methods: Data of all subsequent patients who underwent TPVI with the Edwards Sapien valves in conduits ≤16 mm between 2010 and 2020 were analyzed.

Result: In n = 33 cases, median age was 13 years (5–20 years) and median weight was 47 kg (15–91 kg). Preexisting RVOT grafts were n = 28 Contegra conduits and n = 5 homografts (12 mm: n = 15; 14 mm: n = 11; 16 mm: n = 7). Implanted were the Sapien (n = 8), Sapien XT (n = 10) and Sapien 3 valve (n = 15) with 20 mm (n = 4), 23 mm (n = 19), 26 mm (n = 9), and 29 mm (n = 1). Mean minimal RVOT diameter after TPVI was 22.7 ± 2.3 mm (18–30 mm) which is 150% of the mean minimal RVOT diameter before TPVI (15.1 ± 4.3 mm). Covered stents were used in n = 10 cases. Contained conduit rupture occurred in n = 7 cases (21%). Residual RVOT gradients of 5.7 ± 4.9 mm Hg (0–18 mm Hg) showed adequate RV unloading.

Conclusion: TPVI could be performed successfully in all patients. Dilatation of conduits above 150% and a valve/conduit diameter ratio up to 2.4 were feasible and well tolerated. There was a considerable amount of conduit rupture but all were confined and not significant without further need for intervention or surgery.

Publication History

Article published online:
21 February 2021